Professional Standards Authority Academic & Research Conference 2015

Transcription

1 Professional Standards Authority Academic & Research Conference 2015 The Impact of Chiropractic Statutory Regulation The Challenge of Innate Intelligence Francis J H Wilson, DC, MSc, PhD, FRCC, FHEA, FEAC, FBCA

2 Untestable beliefs in chiropractic Palmer s vision of Innate Intelligence I believe, in fact know, that the Universe consists of Intelligence and matter Palmer D.D. (1914). The moral and religious duty of the chiropractor. In: The Chiropractor, p. 10. Beacon Light Printing Company, Los Angeles.

3 Chiropractic vitalism Untestable belief Universal Intelligence Innate Intelligence The nervous system Health

4 Chiropractic vitalism and clinical practice Advert which appeared in the Journal of the National Chiropractic Association in 1954

5 Chiropractic A changing vision Concerning chiropractic as a cure for all, it must be assumed that all modern chiropractors do understand their healing art is of a rather limited scope. To specialise in the treatment of rather few disorders is the tendency today. In this connection one should not underestimate the common sense of the plain people. The man on the street will soon gather facts by experience and make up his mind what kind of treatment is good for his complaints. Gjocih A. (1961). Chiropractic, as it was, as it is. Bulletin of the European Chiropractic Union 1 (6), 5-11.

6 The pursuit of statutory regulation in the UK Publically, in the run up to the Chiropractors Act of 1994, chiropractors: Emphasised science. De-emphasised vitalism. Narrowed their scope of practice. In other words, they linked themselves to the medical paradigm. Yet undercurrents of traditionalism continued to exist. Cant S. & Sharma U. (1999). A New Medical Pluralism? Alternative Medicine, Doctors, Patients and the State, pp UCL Press, London.

7 Beware the spinal trap Simon Singh, The Guardian, 18 April 2008 You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

8 General Chiropractic Council Guidance on the vertebral subluxation complex The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease. Chiropractors are reminded that: when practising, the care they select and provide must be informed by the best available evidence, the preferences of the patient and the expertise of practitioners (GCC Code of Practice and Standard of Proficiency: effective 30 June 2010; section S3.2) when advertising, claims for chiropractic care must be based on best research of the highest standard only. (GCC Guidance on Advertising, March 2010) August 2010

9 Association of Chiropractic Colleges Draft position statement on chiropractic education Chiropractic education and training must adhere to the biopsychosocial model of health care and be underpinned by biologically plausible theory and peer-reviewed research. It should embrace the value of clinical experience, shared decision-making and a patient-centred approach to care. The teaching of vertebral subluxation complex as a vitalistic construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historical context is therefore inappropriate and unnecessary. February 2015

10 Chiropractic vitalism Current claims Chiropractic adjustments correct subluxations, giving the body s innate intelligence a chance to heal and restore function to the body. That s why chiropractic helps people with such things as asthma, ear infections, headaches, sterility, fibromyalgia, blindness, cancer, irritable bowel syndrome, allergies, deafness, tinnitus, headaches, migraines, sleep apnea, respiratory problems, bladder troubles, menstrual cramps, etc. (Accessed )

11 Chiropractic vitalism United Chiropractic Association Core Values We recognize and respect a universal intelligence in all matter and an innate intelligence within a living organism that drives to preserve life and, if uninhibited, will express optimal potential. The nervous system has a central role in regulating, coordinating and integrating the functions of the entire organism. We recognize that interference to innate intelligence (subluxation) diminishes healing capacity, with an alteration in the dynamic interrelationship between mental, physical and social aspects of the whole person. The art of Chiropractic encourages optimal expression of health by the detection, removal (adjustment) and prevention of nervous system interference. To use drugless, minimally invasive techniques to adjust identified subluxations throughout an individual s lifetime. (Accessed )

12 Appraising the impact of statutory regulation in the UK The statutory regulation of chiropractic in the UK has influenced how chiropractors portray themselves and how they practise, however: The challenge of Innate Intelligence has not gone away. We believe what we want to believe, what we like to believe, what suits our prejudices and fuels our passions. Harris S.J. (1986). Clearing the Ground, p. 7. Houghton Mifflin, Boston. The public image of chiropractic and what is said in private are not always the same. The struggle for hearts and minds is ongoing.

13 Looking ahead Recommendations The General Chiropractic Council must continue to engage with the profession to change culture. Through interaction with chiropractic associations and educational institutions; through registration, continuing professional development and revalidation; and through its response to complaints. Educational institutions must emphasise biologically plausible theories and evidence-based practice. The GCC must ensure that undergraduate education is congruent with the medical orthodoxy and current scientific understanding. Practitioners must be held to account. In addition to responding to complaints, if the public image of chiropractic and the private reality are not always the same then we should consider whether there is a place for practice inspections and/or the use of mystery shoppers.

14 Looking ahead Recommendations Regulators must work together to ensure good practice. Systems of belief which have not or cannot be verified through scientific investigation are not unique to chiropractic. Similar ideas exist within osteopathy and within other CAM practices, including disciplines regulated through the Professional Standards Authority s Accredited Register Programme. The choices of patients must be respected. Members of the public choose to consult practitioners of many different types. Some of the care provided is supported by high quality research evidence, but much of it is not. Patient choice must be respected, but regulated healthcare professionals must not abuse their position of authority by promoting mysticism as a foundation for practice. We should keep an open mind, but not so open that our brains fall out.